Step 4 - Claim Entry For Rocky Shore, West Point, Sunset Springs, Maple Hills, and Hidden Cities (CMS-1500 Form)

 Training Video

After completing the Patient Registration section, the next step in the patient visit process is Claim Entry.  Post all charges contained in the Claim Entry section of the workbook.   

Following are the page numbers for each Claim Entry section:

 Rocky Shore pg 181   West Point pg 325

 Rocky Shore A pg 135  West Point A pg 315

 Rocky Shore B pg 193  West Point B pg 365

 Rocky Shore C pg 249  Sunset Springs pg 595
 Maple Hills pg 779
 Hidden Cities pg 901

Select the Claim –F1 to enter each encounter form (claim).   

Review the Buttons
It is important to become familiar with and understand the functionality of the buttons in Claim –F1.  The buttons are:



Add: Select this if you want to add this claim to a patient other than the one listed in the top blue bar.  In other words, you are working on a new patient and need to Select Patient at the beginning of your claim entry.  After you have retrieved your patient, its defaults display.

Add for Active Patient: Select this if you want to add this claim to the patient listed in the top blue bar (which is considered your active patient).

Find for Active Patient: Select this if you want to view or update a claim for the patient listed in the blue bar (active patient).  You can also make changes/updates to this claim and click the Save button.

Find: This enables you to perform a search for an existing claim for any patient.  You can also make changes/updates to this claim and click the Save button.

Import: Not applicable.

Review the Tabs

There are eight tabs across the top of each claim.  The first three tabs contain all the necessary information to complete the CMS-1500 form.

1.     Claim: Contains rendering and referring provider, facility and insurance information, and claim authorization #.

2.     Charges: Enter ICD codes, CPT codes, and all relevant charges and payments.

3.     Additional Info: Enter accident information, hospitalization, unable to work, and last menstrual period dates.

4.     Insurance: View patient’s current payer and update ID numbers.

5.     Activity: View transactions for this claim.

6.     Notes: Not applicable.

7.     Documents: Not applicable.

8.     Review: Not applicable.


How Many Claims Per Patient?
It is important to verify the number of claims your assignment requires.  This information is located in the third column on the Patient Listing report in the workbook. 

 Following are the page numbers for the Patient Listing report:

 Rocky Shore pg 110   West Point pg 280

 Rocky Shore A pg 108  West Point A pg 298

 Rocky Shore B pg 168  West Point B pg 348

 Rocky Shore C pg 226  Sunset Springs pg 546
 Maple Hills pg 702
 Hidden Cities pg 848

Add a New Claim to a Patient
Before assuming you need to Add a claim, it is important to verify the number of claims your assignment requires.    

To add a claim to a patient, click the Add or Add for Active Patient button.


     1.  If you click the Add button, you must immediately click the Select Patient button and search for the desired patient.


     2.    If you click the Add for Active Patient button, the patient name that is listed in the top blue bar will populate in the 1 Claim tab.


Find an Existing Claim

You can retrieve an existing claim to fix errors.  To find a claim, click the Find or Find for Active Patient button.

1.    When you click the Find button, the Claim Selection Window displays.  You can search by the partial or full last name in  Patient Last Name field.  Now click the Search button.  If this patient has multiple claims, a selection box displays for you to click on the correct date of service claim.

1 Claim Tab

Most of the previously entered patient information will default here.  Double check the information that does default, and complete the remaining fields.

 *    Should be defaulted from the initial Patient –F2 entry.

**   Needs to be completed with claim information provided in the workbook .

1.     Claim Complete: All claims will save as Complete, unless when you click the Save button, an information screen informs you             that your claim is incomplete and asks if you would like to continue to save as “incomplete.”  If you choose to save your claim             as incomplete, you must remember to get the appropriate information and enter it in the incomplete claim, and then reselect             Claim Complete - “Yes” and click the Save button.  A claim complete “NO” results in a score of 0 (zero).

2.     *Select Patient: When you are adding a claim, you will need to search for your patient here.  Once selected, the defaults from          the patient registration process will populate.

3.     *Select Rendering Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1 Patient         tab.  Listed at the top of the encounter form is the provider who is treating the patient.

4.     Select Billing Provider: This field will default from the rendering provider field.

5.     **Select Referring/PCP Provider: A provider will default if already entered in the Defaults tab found under the Patient -F2, 1             Patient tab.  You can also select it here.  

6.     **Select Facility: If a provider mainly sees patients at a clinic, but happens to perform procedures at a facility, the facility is                 indicated on the encounter form for you to enter.  If you select a facility, you must use a POS (Place of Service) code of either             21 or 22 (In-Patient or Out-Patient, respectively) when completing the 2 Charge tab.

7.     *Select Primary/Secondary Insurance: If the payer information does not default here, then return to Patient –F2 and                         complete the required payer information (primary insurance under the 2 Insured tab; secondary insurance under either 2                     Insured tab or 3 Other Insured tab).  Then go to 4 Misc. Info tab, check B, and click the Save button.
8.    Form Version CMS-1500: The version number of the claim. 
9.     **Authorization #: If an authorization number is given on the encounter form, enter it here.  You MUST click the
        Copy Authorization to Claim button.

2 Charges Tab

Next, enter the ICD (diagnostic codes), Dates of Service(s), POS, TOS, CPT, Modifiers, Unit Price, Units, Total Charges, and Payment made in the office at that time of the visit.  Press Tab on the keyboard to continue to the next field.  Screen fields and their description are as follows:


 1.     ICD #: Enter the ICD (diagnostic) code [including period (.)].

 2.     Set Rows: Set the number of rows to the number of procedure codes you need to enter.

 3.     From / To: The “From” date of service and “To” date of service.

 4.     POS: Place of Service; see dropdown for selection.  It defaults 11 for office, but if you have chosen a facility under the      
        1 Claim tab, you will choose POS 21 or 22 (In-Patient or Out-Patient, respectively).

 5.     TOS: Enter Type of Service; see dropdown for selection.  Your choice should relate to the section in which the procedure code          is found in the CPT manual.

 6.     CPT: Enter the charge code that indicates the procedure performed.

 7.     M1, M2, M3, M4: Means Modifier 1, Modifier 2, etc.  You can enter up to 4 modifiers per charge.

 8.     D1, D2, D3: Means Diagnosis Pointer 1, Diagnosis Pointer 2, etc.  The number of D columns that displays should match the   
         number of ICD codes entered above. 

 9.     Unit Price: Enter the price of the procedure.

10.   Units: Enter the number of times this CPT code is performed.

11.   Total Charges: Auto-calculates to equal unit price multiplied by units (unit price x units = total charge).

12.   Status: Defaults based on if the payer is electronic or paper.

13.   Copay: Amount and method to be entered if indicated on the encounter form.


3 Additional Info Tab

Sometimes important boxes on the CMS-1500 form need to be completed, and these fields are under this tab.  Notice the fields are indicated by their corresponding box on the CMS-1500 form.

The most common boxes to complete under this tab based on the information on the encounter forms are:

Box 10:  Accident information is set to “No,” but if it is “Yes,” you must indicate that here.  If it is an auto accident, you must indicate the Accident State, which means the abbreviations of the state in which the accident occurred.  If you choose “Yes” to one of the three types     of accidents (employment, auto, other), you must also complete Box 14 (date of accident) and list last an E diagnostic code(s) under
    the 2 Charges tab.

Box 14: Date of Onset of Illness or Accident (or Injury). 

Box 16: Date unable to work; “From” and “To” dates.

Box 18: Hospitalization dates; if the current claim is a result of a prior hospitalization, enter the dates here. 

Last Menstrual Period date (box 14).


4 Activity Tab
The Activity report lists the activities for all charges on this claim only.  This is a good way to confirm postings (both charges and EOB's) and aging.
Click the List Activity button.  The report will display for you to view, or you can Print this activy report.

Save Your Work and Print the Claim
After completing the 1 Claim tab, 2 Charges tab, and 3 Additional Info tab, it is time to save and/or print the claim. 


If you don’t want to Save your work, click the Close button.